NutriStack
Ginkgo Biloba and Rivaroxaban, a caution.
Ginkgo biloba is a potent platelet-activating factor (PAF) antagonist and has been linked in case reports to spontaneous intracranial, ocular, and postoperative bleeding. Added to rivaroxaban's factor Xa inhibition, the antiplatelet effect of ginkgo creates an additive bleeding risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Ginkgo Biloba and Rivaroxaban
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Ginkgo biloba is a potent platelet-activating factor (PAF) antagonist and has been linked in case reports to spontaneous intracranial, ocular, and postoperative bleeding. Added to rivaroxaban's factor Xa inhibition, the antiplatelet effect of ginkgo creates an additive bleeding risk.
Mechanism. Ginkgolides, especially ginkgolide B, are potent PAF antagonists that inhibit platelet aggregation and prolong bleeding time. This pharmacodynamic antiplatelet effect is additive to rivaroxaban's direct factor Xa inhibition.
Recommendation. Avoid ginkgo biloba while taking rivaroxaban. If you have been combining the two, stop the ginkgo and call your prescriber if you notice unusual bruising, nosebleeds, or any sign of bleeding.
Sources (2)
- Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med. 2005;20(7):657-61. PMID 16050865
- Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy. 2011;31(5):490-502. PMID 21923430
Stack Score
How this pair moves the number.
Effect on the composite score
If both Ginkgo Biloba and Rivaroxaban are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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